Department of Medicine, University of Western Ontario, London, Ontario, Canada.
Kidney Int. 2012 Oct;82(8):903-8. doi: 10.1038/ki.2012.227. Epub 2012 Jun 13.
Intravenous bisphosphonates can cause acute kidney injury; however, this risk was not found with oral bisphosphonates in randomized clinical trials with restrictive eligibility criteria. In order to provide complementary safety data, we studied the risk of acute kidney injury in a population-based cohort of 122,727 patients aged 66 years and older discharged from hospital following a new fragility fracture and no history of bisphosphonate use in the prior year. Bisphosphonate treatment was identified within 120 days after discharge and event rates were measured from 90 days of therapy initiation. The primary outcome was hospitalization with acute kidney injury with secondary outcomes of new nephrology consultation and, in a subset of patients with laboratory values, acute kidney injury was defined as an increase in serum creatinine. We identified 18,286 bisphosphonate users and 104,441 non-users with a mean age of 81 years. Of 5772 patients with laboratory values, 40% had chronic kidney disease (eGFR <60 ml/min per 1.73 m(2)). Overall, there was no statistically significant difference in the risk of acute kidney injury among bisphosphonate users compared to non-users (adjusted odds ratio 1.03), and no significant differences in other outcomes or in subgroups of patients with baseline chronic kidney disease. Thus, in this older population-based cohort, oral bisphosphonate use was not associated with acute kidney injury.
静脉注射双膦酸盐可引起急性肾损伤; 然而，在具有限制资格标准的随机临床试验中，并未发现口服双膦酸盐有这种风险。为了提供补充安全性数据，我们研究了 122727 名年龄在 66 岁及以上的人群的风险，这些人在新发生脆性骨折后从医院出院，且在过去 1 年内没有使用双膦酸盐的病史。在出院后 120 天内确定双膦酸盐治疗，并从治疗开始后 90 天测量事件发生率。主要结局是发生急性肾损伤的住院治疗，次要结局是新的肾病咨询，以及在具有实验室值的患者亚组中，急性肾损伤定义为血清肌酐增加。我们确定了 18286 名双膦酸盐使用者和 104441 名非使用者，平均年龄为 81 岁。在有实验室值的 5772 名患者中，40%有慢性肾脏病 (eGFR <60 ml/min/1.73 m(2))。总体而言，与非使用者相比，双膦酸盐使用者发生急性肾损伤的风险无统计学差异 (调整后的优势比 1.03)，其他结局或有基线慢性肾脏病的患者亚组中也无显著差异。因此，在这个年龄较大的基于人群的队列中，口服双膦酸盐的使用与急性肾损伤无关。
